This week, renowned cancer researcher Dr. Brian Druker announced he was resigning his position as CEO of the Knight Cancer Institute. Druker is continuing on as a professor of medicine and a member of the OHSU Knight Cancer Institute.
Druker is one of a handful of researchers at OHSU whose work is known worldwide. In the 1990s, he helped develop a drug that turned a fatal form of leukemia into a survivable illness. The discovery led to a new class of cancer drugs and earned him the Lasker-DeBakey Clinical Medical Research Award, among the highest honors in research science. He was also instrumental in raising $1 billion to launch the Knight Cancer Institute in 2015.
In a letter to colleagues this week, published in full by the Lund Report, Druker wrote that he could no longer achieve his goals to advance cancer research and improve patient care at OHSU.
“We have lost sight of what is crucial and forgotten our mission,” he wrote.
FILE - Dr. Brian Druker, right, speaks to a researcher at an unknown location on Oct. 3, 2017.
Kristian Foden-Vencil / OPB
Druker told OPB that a lack of strategic focus and spiraling financial concerns at OHSU have made it impossible for him to recruit the researchers he needs to be competitive in the field of cancer research.
Over the past year, the Knight Institute had been trying to hire a top computational biologist. Druker said the candidate was a tenured professor at Harvard Medical School.
“He was sent an offer letter by OHSU offering him 25% of his current salary,” Druker said. “He was kind enough to call us back and say, ‘was there some kind of a mistake?’ Unfortunately, there was not.”
The incident was embarrassing, Druker said, and emblematic of a broader unwillingness at the institution to pay people what they’re worth.
In a wide-ranging interview with OPB health reporter Amelia Templeton, he shared more about the work he hopes to do in the future, and the message he wants to send: that OHSU isn’t valuing its frontline workers enough, and is too blindly focused on the need to control its costs.
This interview transcript has been lightly edited for concision, clarity, and length.
Amelia Templeton: In your letter announcing that you are resigning, you wrote that there is more that you want to do to advance cancer research and improve patient care. You’ve accomplished some pretty significant things.
The largest ever challenge donation [in 2015, Druker helped OHSU raise a record-breaking $500 million, earning a $500 million match from Phil and Penny Knight that launched the Knight Cancer Institute]. Developing a whole new class of cancer drugs. So what were you thinking of, when you wrote that there is more you want to do?
Brian Druker: There are a couple of things that I believe need to be done. I can break them down into my own research, which is in a particular leukemia, where we took life expectancy from 3 to 5 years, to now we expect people to live a normal lifespan. But they have to take a pill every day. So my laboratory question is, what is it about those cells, those last few cells, that we can’t kill? Because if we stop their medication, their leukemia comes back.
If I could figure that out, I could take this leukemia from a manageable condition, to a curable condition. That might also give us insight into other cells that can persist despite chemotherapy and other treatments.
On the clinical side, I’ve talked a lot about patients navigating the cancer experience. You hear the words “You have cancer,” and your mind goes numb.
And then we ask you to make 25 appointments and see five doctors and get a bunch of X-rays and bombard you with information. We can do a much better job of navigating that, at least that initial intake.
Then, all the symptoms and side effects that come along with treatment. Then, moving to survivorship, it’s not like you ring the bell when your chemotherapy is done. “See you later, you’ll be fine.” What about all the side effects that the treatments have caused, how do we manage that? How do we help you get back to the healthiest life possible? So, those are the sorts of things I’d like to be involved in.
Templeton: Is there a place you’d love to go?
Druker: I still love Oregon and I love OHSU and if there are things that I can do here, I will. I’ve looked at one company that has a drug in clinical trials that might cure hepatitis B. Wouldn’t that be amazing! That would have a world changing impact. I got into this career to help people, and that’s my true north.
Templeton: You are a prominent researcher, you are a leader. And sometimes when people like you resign in this way, it is a warning signal. A red flag that policymakers need to understand and react to, to right the ship.
Help me understand: To what extent is this just that this wasn’t personally the right fit for you anymore, versus OHSU has some systemic problems that it needs to fix if it wants to retain and keep top researchers?
Druker: Some of this is personal, but some of it is things that have been reported about OHSU and the leadership here.
If you look at our employee engagement survey, morale is incredibly low. Trust of our senior OHSU leaders is extremely low. There’s been a culture of fear and intimidation. And in addition, there’s been a lack of setting a vision for what we want to excel. There’s been more of a focus on what our finances are, and what do we need to do so we don’t lose as much money as we’re losing. What that means is the mentality has become, “well we’re gonna have to make some cuts” so that you’re gonna do twice as much work making the same amount of money.
As dedicated physicians and nurses and health care providers, we’re going to do everything we can for our patients, but it just feels like, “Why are we doing this?” We went into medicine to help people, and we want to do something bigger than ourselves.
Templeton: Can you give me an example of a cut that you had to either communicate to your team or your staff or that affected you that fits this pattern?
Druker: We had the leader of our oncology group take an amazing job elsewhere. He did incredible work recruiting behind him so that when he left, we didn’t actually have to replace him. We could divide his responsibilities amongst a couple of people that were in the wings ready to go. And I had difficulty justifying [to OHSU] giving these two individuals, for taking on substantially more responsibility, a higher title and a raise. I’m actually saving the institution money, by not having to hire a new person, but by distributing responsibilities, and now I’m having to ask people to take on more responsibility, without more pay?
That’s the mindset of cost containment. We’re kind of being pennywise and pound foolish, in terms of not wanting to honor the work that people are doing.
Templeton: You’d also mentioned in your conversation with the Lund Report that there’s been so much growth, and perhaps growth too quickly. Part of OHSU’s strategy to deal with its financial losses has been to propose acquiring Legacy Health, another struggling institution. Are you concerned about that strategy?
Druker: From a long-term perspective it makes sense. From a short-term, it’s gonna be incredibly challenging to think about two institutions that are losing money, somehow combining and making money. The projections are, the first two or three years are gonna be substantially in the red ink. What has been lacking has been: What’s the vision for how this is gonna benefit people? What’s the vision for how care is going to be improved? It can’t be about money, it has to be about what’s this going to do that benefits patients in our community. And I can see that there could be many, many opportunities, but they should be communicated.
Templeton: Are you confident that it will ultimately benefit patients in the community, or do you think that’s unclear?
Druker: Oh ultimately, I think it will.
Templeton: On the financial side of things, it’s a little surprising for me to hear that you are experiencing this pushback, this cost containment, given that the Knight Cancer Institute is a place I think of as being generously funded and having been very successful at fundraising.
[Ten years ago, in 2015, Druker helped OHSU raise $500 million to qualify for a $500 million challenge gift from Phil and Penny Knight. At the time, OHSU reported the $1 billion set a national fundraising record. The Knights began giving in 2017, and the last donation is scheduled for 2027.]
Templeton: Is some of what’s happening here that you’re looking at needing to figure out what comes next and potentially another very significant fundraising lift?
Druker: What we did from day one, before we spent the dime, is we outlined the sustainability plan.
Starting day one, we looked at what happens in 2027, when the Knight family writes their last check to us. Are we going to fall off a cliff, or are we going to sustain? We made sure we had a plan for sustainability. That’s all baked in. We are not going to fall off a cliff in 2027.
Templeton: Is that through some sort of endowment or some mechanism like that?
Druker: Yes, it’s a combination of grant funding, endowment, philanthropic investment, clinical revenue. We looked at all sources of income and made sure that when 2027 comes we are still running full speed.
Templeton: Why is it, given the incredible fundraising success that you’ve had, that the Knight Institute isn’t more insulated from this cost-containment that’s going on?
Druker: There’s any number of issues. First of all, we have the Oregon Pay Equity Act, so we have to make sure that the salaries we pay are equitable with the rest of the institution.
Some of our funding comes from the hospital and their margin, and profits. So if they’re making cuts across the institution, they’re asking that we participate, and that’s fair.
Templeton: My last question is is there anything about the way that this has been reported so far that you either didn’t expect or that you wanna correct? Any impressions you’ve left that you wanted to dispel.
Druker: I thought hard about the line in the piece about, “OHSU has lost sight of its mission.” I felt that that needed to be there, because that’s the mood at this institution. The general feeling is that we haven’t set a vision, we haven’t set priorities, we haven’t had a strategy. And I felt that it would’ve been disingenuous for me to step away and not give a reason.
We have to think about what it is that we’re doing, and making sure that our frontline workers who are busting their tails to take care of our patients, their voices are heard, and that their voices are valued, and that they feel as though they’re doing something that everybody here values.
I’m just hoping that the message gets across that we have to do things differently here.
